Radiological Defense and Decontamination ======================================== þ Triage - acute radiation exposure: if vomiting in about 30 minutes, will die (from Chernobyl). - Six-level triage system (ARLS, 2008) - Getting a RADEF history þ Treatment - may need irradiated (totally sterile) transfusion products - may need to do prophylactic gut sterilization - may want to give glutamine, glutathione, Vits A C and E as radioprotectants, Carafate. - There is no emergency with radiation exposure, but there is an urgency; if there are contaminants inside, you want to get them out before they get into the bones. - DTPA needs to be given within hours to be effective; innocuous for the most part. EDTA OK, but lots of side effects, especially with repetitive doses. þ Radiological Principles þ Radiobiology þ Radiological Decontamination - Cut, Don't Tear - Cut Top to Bottom, away from Wounds - Fold Outer Surfaces away from Skin - Change Gloves after Handling Clothes, Sheets, Blankets - Save Dressing / Collect Specimens - Drape (to Drain Fluids) - Cleanse - Usual Wound Cleansing Procedures & Wound Cleansing Agents - Remove Drapes & Survey - Repeat PRN - Dress Wounds w / Waterproof Cover before Cleansing other Areas - Intact skin: + Use Warm Water + Use Mechanical action of Flushing, Friction of Cleansing Pad + Showering - Proceed from Head to Feet. + Keep Materials out of Orifices and Wounds. Waterproof Draping Limits Spread. + Avoid Damaging Skin (Avoid Erythema). - When to stop? + When No More Comes Off! + Stop Levels: + 1 mR/h beta + 1000 dis / min alpha (air proportional counter w / 60cm2 Window) - If the Committed Dose would Not Exceed 15 rem / yr to Skin - Isolate w / Bag & Continue Decon Next Day - Hair and Hairy Areas + Multiple Washings + Cut, Don't Shave + Finger and Toenails - To prevent incorporation: + Interception before radionuclide reaches target organs + Decrease body uptake + Vomit / Lavage + Charcoal / Catharsis + other Methods þ Uranium Toxicity - Implanted uranium, from depleted uranium shrapnel, may get renal failure from nephrotoxic non-radiologic effects of uranium. - Alkaline urine will help excretion of uranium. þ Radiological Decorporation - radiologicals may become "incorporated" into body tissues. - removing this is called "decorporation" - incorporation may occue in wounds or by inhalation - Physiologic Principles Used in Radionuclide Decorporation + Gi Tract Removal / Enhanced Elimination + Dilution of Isotope + Displacement + Blocking + Alkalinization + Chelation + Reduction of Absorption + Antacid + Precipitation into Soluble Salt + Catharsis - Chelating + chelating agents can remove transuranics and certain heavy metals. Therefore, the chelating agent DTPA (diethylenetriaminepentaacetic acid) can be administered to form a stable, excretable complex with the plutonium. + Nuclear medicine departments may have stock DTPA solutions, but they are usually too dilute to use as chelators for patients with who have incorporated nuclear material into their bodies (for instance, through inhalation or ingestion). The Radiation Emergency Assistance Center/Training Site (REAC/TS) in Oak Ridge, Tennesse can provide DTPA to those who need it. - Decontamination of wounds: + Unless the extremity is so severely traumatized that functional recovery is unlikely or severe radiation-induced necrosis is expected due to the severity of exposure, amputation is rarely indicated. "Decontaminate, but do not mutilate." Debride instead. Ref: Tintinalli, 3rd ed. p712. - Lung Lavage: Does Not Need to be Done Emergently (3-5 days after Exposure) - Cesium Cs-137: use insoluble Prussian blue + Binds ions in the Gut + Biological Half-Life Reduced to 1/3 + Not Systemically Absorbed + Side Effects - Constipation, Gi Upset at Higher Doses (20 g / day) - Tritium: dilute with beer (drink a lot) - Iodine or Technitium: + Treat within 4 Hours (Best 1 Hour Before Exposure!) - Kl or Nal 300 mg tablet - SSKI (1 g / ml) - 5 - 6 drops in water - Povidone Iodine Theoretically Useful - Radiation Terrorism Weapon Types - Radiation Response Agencies